Difference between revisions of "Bleeding disorders and risk"

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Incomplete information; this section will be expanded, clarified, and with references added in the future.
 
Incomplete information; this section will be expanded, clarified, and with references added in the future.
−
 
 
==Initial evaluation==
 
==Initial evaluation==
 
*Bleeding history (acquired or inherited disorder?)
 
*Bleeding history (acquired or inherited disorder?)
Line 24: Line 16:
 
*Kidney disease (uremia)
 
*Kidney disease (uremia)
 
*Medications: [[:Category:Anticoagulants | anticoagulants]], [[:Category:Antiplatelet agents | antiplatelet medications]] such as [[aspirin]] and [[Clopidogrel (Plavix)]], NSAIDS, [[Antidepressants and other psychiatric medications in cancer care | antidepressants which cause decrease in platelet function]]
 
*Medications: [[:Category:Anticoagulants | anticoagulants]], [[:Category:Antiplatelet agents | antiplatelet medications]] such as [[aspirin]] and [[Clopidogrel (Plavix)]], NSAIDS, [[Antidepressants and other psychiatric medications in cancer care | antidepressants which cause decrease in platelet function]]
 +
*Vitamin C (scurvy). No fruits or vegetables in diet?
  
 
==Bleeding Score==
 
==Bleeding Score==
 
This is a quantitative assessment of bleeding risk based on history, and can predict the likelihood of VWD Type I.
 
This is a quantitative assessment of bleeding risk based on history, and can predict the likelihood of VWD Type I.
 
*[http://www.hematology.org/Clinicians/Guidelines-Quality/538.aspx ASH Pocket Guides App] contains several calculators including the bleeding score calculator
 
*[http://www.hematology.org/Clinicians/Guidelines-Quality/538.aspx ASH Pocket Guides App] contains several calculators including the bleeding score calculator
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# Tosetto A, Rodeghiero F, Castaman G, Goodeve A, Federici AB, Batlle J, Meyer D, Fressinaud E, Mazurier C, Goudemand J, Eikenboom J, Schneppenheim R, Budde U, Ingerslev J, Vorlova Z, Habart D, Holmberg L, Lethagen S, Pasi J, Hill F, Peake I. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost. 2006 Apr;4(4):766-73. [https://lup.lub.lu.se/search/publication/416336 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/16634745 PubMed]
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# Tosetto A, Rodeghiero F, Castaman G, Goodeve A, Federici AB, Batlle J, Meyer D, Fressinaud E, Mazurier C, Goudemand J, Eikenboom J, Schneppenheim R, Budde U, Ingerslev J, Vorlova Z, Habart D, Holmberg L, Lethagen S, Pasi J, Hill F, Peake I. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost. 2006 Apr;4(4):766-73. [https://lup.lub.lu.se/search/publication/416336 link to original article] [https://pubmed.ncbi.nlm.nih.gov/16634745/ PubMed]
  
 
==Abnormal PT/INR or PTT==
 
==Abnormal PT/INR or PTT==
Line 44: Line 37:
 
*Elevated PTT only
 
*Elevated PTT only
 
**Heparin
 
**Heparin
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**Deficiencies of factor VIII, factor IX, factor XI, factor XII, or inhibitors
+
**Deficiencies of factor VIII, factor IX, factor XI, factor XII, or inhibitors.
 +
**Not associated with increased bleeding risk: Prekallikrein deficiency, high molecular weight kininogen deficiency, factor XII deficiency
 
**von Willebrand disease
 
**von Willebrand disease
 
**Lupus anticoagulant
 
**Lupus anticoagulant
Line 54: Line 48:
  
 
[[Category:Hematology reference pages]]
 
[[Category:Hematology reference pages]]
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[[Category:Clinical pharmacology]]

Latest revision as of 17:34, 7 September 2023

Incomplete information; this section will be expanded, clarified, and with references added in the future.

Initial evaluation

  • Bleeding history (acquired or inherited disorder?)
    • Spontaneous or provoked by surgery, tooth extraction, etc.
    • Tolerance of prior surgery
    • Menses
    • Mucocutaneous bleeding, petechiae, oozing at line sites
    • Bruising, hemarthrosis
    • Family history--known hemophilia A, hemophilia B, von Willebrand disease (VWD), platelet function disorder
    • Need for transfusion or product
  • History of trauma, surgery
  • PT/INR
  • PTT
  • Platelet count
  • +/- fibrinogen (DIC), D-dimer, fibrin/fibrinogen degradation products (FDP)
  • Kidney disease (uremia)
  • Medications: anticoagulants, antiplatelet medications such as aspirin and Clopidogrel (Plavix), NSAIDS, antidepressants which cause decrease in platelet function
  • Vitamin C (scurvy). No fruits or vegetables in diet?

Bleeding Score

This is a quantitative assessment of bleeding risk based on history, and can predict the likelihood of VWD Type I.

  1. Tosetto A, Rodeghiero F, Castaman G, Goodeve A, Federici AB, Batlle J, Meyer D, Fressinaud E, Mazurier C, Goudemand J, Eikenboom J, Schneppenheim R, Budde U, Ingerslev J, Vorlova Z, Habart D, Holmberg L, Lethagen S, Pasi J, Hill F, Peake I. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost. 2006 Apr;4(4):766-73. link to original article PubMed

Abnormal PT/INR or PTT

  • 1:1 mixing study (50/50 mixing study, circulating anticoagulant)
  • Liver disease
  • Elevated PT only
    • Vitamin K deficiency
      • Warfarin
      • Dietary habits
      • Antibiotic use
      • Malnutrition
      • Increased gut motility
    • Deficiency or inhibitor of factor VII
    • Lupus anticoagulant (rarely)
  • Elevated PTT only
    • Heparin
    • Deficiencies of factor VIII, factor IX, factor XI, factor XII, or inhibitors.
    • Not associated with increased bleeding risk: Prekallikrein deficiency, high molecular weight kininogen deficiency, factor XII deficiency
    • von Willebrand disease
    • Lupus anticoagulant
  • Elevated PT & PTT
    • Deficiences of prothrombin (factor II), factor V, factor X, fibrinogen
    • DIC

References

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